Hemophilia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Patients with hemophilia usually appear normal. Physical examination of patients with hemophilia is usually remarkable for tachycardia, pallor, bruising, abdominal pain and distension, hypotension, and muscle or joint swelling.

Physical Examination

Physical examination of patients with hemophilia is usually remarkable for tachycardia, pallor, hypotension, and muscle or joint swelling.^[1]^[2]^[3]^[4]^[5]

Appearance of the Patient

Patients with hemophilia usually appear normal.

Vital Signs

Skin

HEENT

HEENT examination of patients with hemophilia is usually normal.
Findings related to the complications may include:

Pupillary changes^[7]
Bulging tense fontanelle in infants^[13]
Bruises
Respiratory distress^[14]

Neck

Lungs

Pulmonary examination of patients with hemophilia is usually normal.

Heart

Cardiovascular examination of patients with hemophilia is usually normal.

Abdomen

Abdominal examination of patients with hemophilia is usually normal.
Findings related to the complications may include:

Back

Back examination in patients with hemophilia is usually normal.

Genitourinary

Genitourinary examination in patients with hemophilia is usually normal.

Neuromuscular

Neuromuscular examination of patients with hemophilia is usually normal.

Extremities

Swelling^[2]^[19]^[4]^[5]
Tenderness^[20]^[8]^[21]^[22]^[21]

References

↑ ^1.0 ^1.1 ^1.2 Pham TV, Sorenson CA, Nable JV (February 2014). "Acquired factor VIII deficiency presenting with compartment syndrome". Am J Emerg Med. 32 (2): 195.e1–2. doi:10.1016/j.ajem.2013.09.022. PMID 24176587.
↑ ^2.0 ^2.1 De la Corte-Rodriguez H, Rodriguez-Merchan EC (December 2014). "Treatment of muscle haematomas in haemophiliacs with special emphasis on percutaneous drainage". Blood Coagul. Fibrinolysis. 25 (8): 787–94. doi:10.1097/MBC.0000000000000159. PMID 24914744.
↑ Peterson, Lars (2001). Sports injuries : their prevention and treatment. London: Martin Dunitz. ISBN 0203419561.
↑ ^4.0 ^4.1 Tsuyama N, Ichiba T, Naito H (2016). "Unusual Initial Manifestation of Acquired Hemophilia A: A Normal Activated Partial Thromboplastin Time, Intramuscular Hematoma and Cerebral Hemorrhage". Intern. Med. 55 (22): 3347–3349. doi:10.2169/internalmedicine.55.7219. PMC 5173506. PMID 27853081.
↑ ^5.0 ^5.1 Pitcher, G. J.; Bowley, D. M. G.; Chasumba, G.; Zuckerman, M. (2002). "Life-threatening haemorrhage from a gastric Dieulafoy lesion in a child with haemophilia". Haemophilia. 8 (5): 719–720. doi:10.1046/j.1365-2516.2002.00675.x. ISSN 1351-8216.
↑ DeWitt ES, DiMichele DM, Larsen K, Pass RH (July 2010). "Successful cryoablation of atrioventricular nodal reentrant tachycardia in a child with hemophilia A". J. Pediatr. Hematol. Oncol. 32 (5): 404–6. doi:10.1097/MPH.0b013e3181e0040d. PMID 20505535.
↑ ^7.0 ^7.1 Peltier J, Baroncini M, Thines L, Leteurtre S, Marey A, Vinchon M (February 2012). "[Haemophilia A and intracranial bleedings in infants]". Neurochirurgie (in French). 58 (1): 19–24. doi:10.1016/j.neuchi.2012.01.003. PMID 22385799.
↑ ^8.0 ^8.1 Franchini, Massimo; Mannucci, Pier Mannuccio (2013). "Hemophilia A in the third millennium". Blood Reviews. 27 (4): 179–184. doi:10.1016/j.blre.2013.06.002. ISSN 0268-960X.
↑ Shen CY, Fu LS, Lin HK, Han SM, Wang JD (November 2012). "Macrohematuria as initial presentation in a girl with factor VIII and factor IX inhibitors associated with systemic lupus erythematosus". J. Pediatr. Hematol. Oncol. 34 (8): e344–5. doi:10.1097/MPH.0b013e3182678ec1. PMID 23018565.
↑ Ries M, Klinge J, Rauch R, Chen C, Deeg KH (1998). "[Spontaneous subdural hematoma in a 18-day-old male newborn infant with severe hemophilia A]". Klin Padiatr (in German). 210 (3): 120–4. doi:10.1055/s-2008-1043862. PMID 9629545.
↑ ^11.0 ^11.1 Anjay MA, Sasidharan CK, Anoop P (April 2012). "Hepatic subcapsular hematoma: two neonates with disparate presentations". Pediatr Neonatol. 53 (2): 144–6. doi:10.1016/j.pedneo.2012.01.013. PMID 22503263.
↑ Sachdeva A, Gunasekaran V, Ramya HN, Dass J, Kotwal J, Seth T, Das S, Garg K, Kalra M, Sirisha RS, Prakash A (July 2018). "Consensus Statement of the Indian Academy of Pediatrics in Diagnosis and Management of Hemophilia". Indian Pediatr. 55 (7): 582–590. PMID 30129541.
↑ Bhattacharya D, Sharawat IK, Saini L (May 2018). "Intraventricular haemorrhage and obstructive hydrocephalus in a term neonate: an uncommon presentation of haemophilia B". BMJ Case Rep. 2018. doi:10.1136/bcr-2018-225341. PMID 29848541.
↑ Moreira A, Das H (2018). "Acute Life-Threatening Hemorrhage in Neonates With Severe Hemophilia A: A Report of 3 Cases". J Investig Med High Impact Case Rep. 6: 2324709618800349. doi:10.1177/2324709618800349. PMC 6144491. PMID 30246038.
↑ ^15.0 ^15.1 LEATHERDALE RA (April 1960). "Respiratory obstruction in haemophilic patients". Br Med J. 1 (5182): 1316–20. PMC 1967523. PMID 14414970.
↑ ^16.0 ^16.1 Delibegovic M, Alispahic A, Gazija J, Mehmedovic Z, Mehmedovic M (June 2015). "Intramural Haemorrhage and Haematoma as the Cause of Ileus of the Small Intestine in a Haemophiliac". Med Arch. 69 (3): 206–7. doi:10.5455/medarh.2015.69.206-207. PMC 4500296. PMID 26261394.
↑ Eleftheriadis N, Makris P (October 2010). "Portal vein thrombosis in a patient with HCV cirrhosis and combined hemophilia A and thrombophilia V Leiden". Ther Clin Risk Manag. 6: 539–41. doi:10.2147/TCRM.S13660. PMC 2988613. PMID 21127694.
↑ Onda M, Urazumi K, Abe R, Matsuo K (1998). "Obstructive Ileus caused by blood clot after emergency total gastrectomy in a patient with hemophilia A: report of a case". Surg. Today. 28 (12): 1266–9. doi:10.1007/BF02482812. PMID 9872546.
↑ Peterson, Lars (2001). Sports injuries : their prevention and treatment. London: Martin Dunitz. ISBN 0203419561.
↑ Berntorp, Erik; Shapiro, Amy D (2012). "Modern haemophilia care". The Lancet. 379 (9824): 1447–1456. doi:10.1016/S0140-6736(11)61139-2. ISSN 0140-6736.
↑ ^21.0 ^21.1 Goto M, Takedani H, Nitta O, Kawama K (2015). "Joint Function and Arthropathy Severity in Patients with Hemophilia". J Jpn Phys Ther Assoc. 18 (1): 15–22. doi:10.1298/jjpta.18.15. PMID 26733762.
↑ Arpaci T, Sasmaz I, Akbas T, Eken A, Ozgur A, Antmen B (April 2016). "Bilateral recurrent external obturator muscle hematoma: An unusual cause of pelvic pain in hemophilia". Mol Clin Oncol. 4 (4): 622–624. doi:10.3892/mco.2016.736. PMC 4812266. PMID 27073678.

Template:WH Template:WS

[pmid24176587-1] 1.0 ^1.1 ^1.2 Pham TV, Sorenson CA, Nable JV (February 2014). "Acquired factor VIII deficiency presenting with compartment syndrome". Am J Emerg Med. 32 (2): 195.e1–2. doi:10.1016/j.ajem.2013.09.022. PMID 24176587.

[pmid24914744-2] 2.0 ^2.1 De la Corte-Rodriguez H, Rodriguez-Merchan EC (December 2014). "Treatment of muscle haematomas in haemophiliacs with special emphasis on percutaneous drainage". Blood Coagul. Fibrinolysis. 25 (8): 787–94. doi:10.1097/MBC.0000000000000159. PMID 24914744.

[3] Peterson, Lars (2001). Sports injuries : their prevention and treatment. London: Martin Dunitz. ISBN 0203419561.

[pmid27853081-4] 4.0 ^4.1 Tsuyama N, Ichiba T, Naito H (2016). "Unusual Initial Manifestation of Acquired Hemophilia A: A Normal Activated Partial Thromboplastin Time, Intramuscular Hematoma and Cerebral Hemorrhage". Intern. Med. 55 (22): 3347–3349. doi:10.2169/internalmedicine.55.7219. PMC 5173506. PMID 27853081.

[PitcherBowley2002-5] 5.0 ^5.1 Pitcher, G. J.; Bowley, D. M. G.; Chasumba, G.; Zuckerman, M. (2002). "Life-threatening haemorrhage from a gastric Dieulafoy lesion in a child with haemophilia". Haemophilia. 8 (5): 719–720. doi:10.1046/j.1365-2516.2002.00675.x. ISSN 1351-8216.

[pmid20505535-6] DeWitt ES, DiMichele DM, Larsen K, Pass RH (July 2010). "Successful cryoablation of atrioventricular nodal reentrant tachycardia in a child with hemophilia A". J. Pediatr. Hematol. Oncol. 32 (5): 404–6. doi:10.1097/MPH.0b013e3181e0040d. PMID 20505535.

[pmid22385799-7] 7.0 ^7.1 Peltier J, Baroncini M, Thines L, Leteurtre S, Marey A, Vinchon M (February 2012). "[Haemophilia A and intracranial bleedings in infants]". Neurochirurgie (in French). 58 (1): 19–24. doi:10.1016/j.neuchi.2012.01.003. PMID 22385799.

[FranchiniMannucci2013-8] 8.0 ^8.1 Franchini, Massimo; Mannucci, Pier Mannuccio (2013). "Hemophilia A in the third millennium". Blood Reviews. 27 (4): 179–184. doi:10.1016/j.blre.2013.06.002. ISSN 0268-960X.

[pmid23018565-9] Shen CY, Fu LS, Lin HK, Han SM, Wang JD (November 2012). "Macrohematuria as initial presentation in a girl with factor VIII and factor IX inhibitors associated with systemic lupus erythematosus". J. Pediatr. Hematol. Oncol. 34 (8): e344–5. doi:10.1097/MPH.0b013e3182678ec1. PMID 23018565.

[pmid9629545-10] Ries M, Klinge J, Rauch R, Chen C, Deeg KH (1998). "[Spontaneous subdural hematoma in a 18-day-old male newborn infant with severe hemophilia A]". Klin Padiatr (in German). 210 (3): 120–4. doi:10.1055/s-2008-1043862. PMID 9629545.

[pmid22503263-11] 11.0 ^11.1 Anjay MA, Sasidharan CK, Anoop P (April 2012). "Hepatic subcapsular hematoma: two neonates with disparate presentations". Pediatr Neonatol. 53 (2): 144–6. doi:10.1016/j.pedneo.2012.01.013. PMID 22503263.

[pmid30129541-12] Sachdeva A, Gunasekaran V, Ramya HN, Dass J, Kotwal J, Seth T, Das S, Garg K, Kalra M, Sirisha RS, Prakash A (July 2018). "Consensus Statement of the Indian Academy of Pediatrics in Diagnosis and Management of Hemophilia". Indian Pediatr. 55 (7): 582–590. PMID 30129541.

[pmid29848541-13] Bhattacharya D, Sharawat IK, Saini L (May 2018). "Intraventricular haemorrhage and obstructive hydrocephalus in a term neonate: an uncommon presentation of haemophilia B". BMJ Case Rep. 2018. doi:10.1136/bcr-2018-225341. PMID 29848541.

[pmid30246038-14] Moreira A, Das H (2018). "Acute Life-Threatening Hemorrhage in Neonates With Severe Hemophilia A: A Report of 3 Cases". J Investig Med High Impact Case Rep. 6: 2324709618800349. doi:10.1177/2324709618800349. PMC 6144491. PMID 30246038.

[pmid14414970-15] 15.0 ^15.1 LEATHERDALE RA (April 1960). "Respiratory obstruction in haemophilic patients". Br Med J. 1 (5182): 1316–20. PMC 1967523. PMID 14414970.

[pmid26261394-16] 16.0 ^16.1 Delibegovic M, Alispahic A, Gazija J, Mehmedovic Z, Mehmedovic M (June 2015). "Intramural Haemorrhage and Haematoma as the Cause of Ileus of the Small Intestine in a Haemophiliac". Med Arch. 69 (3): 206–7. doi:10.5455/medarh.2015.69.206-207. PMC 4500296. PMID 26261394.

[pmid21127694-17] Eleftheriadis N, Makris P (October 2010). "Portal vein thrombosis in a patient with HCV cirrhosis and combined hemophilia A and thrombophilia V Leiden". Ther Clin Risk Manag. 6: 539–41. doi:10.2147/TCRM.S13660. PMC 2988613. PMID 21127694.

[pmid9872546-18] Onda M, Urazumi K, Abe R, Matsuo K (1998). "Obstructive Ileus caused by blood clot after emergency total gastrectomy in a patient with hemophilia A: report of a case". Surg. Today. 28 (12): 1266–9. doi:10.1007/BF02482812. PMID 9872546.

[19] Peterson, Lars (2001). Sports injuries : their prevention and treatment. London: Martin Dunitz. ISBN 0203419561.

[BerntorpShapiro2012-20] Berntorp, Erik; Shapiro, Amy D (2012). "Modern haemophilia care". The Lancet. 379 (9824): 1447–1456. doi:10.1016/S0140-6736(11)61139-2. ISSN 0140-6736.

[pmid26733762-21] 21.0 ^21.1 Goto M, Takedani H, Nitta O, Kawama K (2015). "Joint Function and Arthropathy Severity in Patients with Hemophilia". J Jpn Phys Ther Assoc. 18 (1): 15–22. doi:10.1298/jjpta.18.15. PMID 26733762.

[pmid27073678-22] Arpaci T, Sasmaz I, Akbas T, Eken A, Ozgur A, Antmen B (April 2016). "Bilateral recurrent external obturator muscle hematoma: An unusual cause of pelvic pain in hemophilia". Mol Clin Oncol. 4 (4): 622–624. doi:10.3892/mco.2016.736. PMC 4812266. PMID 27073678.

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